Provider Demographics
NPI:1649827940
Name:BOGGS, DARBY
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NETHERCLIFT WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-3071
Mailing Address - Country:US
Mailing Address - Phone:912-414-1127
Mailing Address - Fax:
Practice Address - Street 1:37 W FAIRMONT AVE STE 323
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3459
Practice Address - Country:US
Practice Address - Phone:912-414-1127
Practice Address - Fax:877-966-6438
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist